Healthcare Provider Details

I. General information

NPI: 1306882246
Provider Name (Legal Business Name): TIPPAH COUNTY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 11/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 CITY AVE N 1005 CITY AVENUE NORTH
RIPLEY MS
38663-1414
US

IV. Provider business mailing address

PO BOX 499
RIPLEY MS
38663-0499
US

V. Phone/Fax

Practice location:
  • Phone: 662-837-9221
  • Fax: 662-837-2110
Mailing address:
  • Phone: 662-837-9221
  • Fax: 662-837-2110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number11-159
License Number StateMS

VIII. Authorized Official

Name: CRAIG CUDSWORTH
Title or Position: CEO
Credential:
Phone: 662-837-9221